ADA's 2026 Standards of Care name semaglutide and tirzepatide as preferred

The American Diabetes Association released its "Standards of Care in Diabetes—2026" on December 8, 2025, and Section 8, covering obesity and weight management, now names two specific medicines as preferred ^[1][2]. Recommendation 8.18 states, at evidence grade A, that pharmacotherapy for people with diabetes and overweight or obesity should be a GLP-1 receptor agonist or a dual GIP/GLP-1 receptor agonist with greater weight loss efficacy, specifically semaglutide or tirzepatide ^[1].

Two companion recommendations address how the drugs are used over time. Recommendation 8.19 says treatment should continue after a person reaches their weight goal, and recommendation 8.20 says the optimal dose may not be the maximum approved dose ^[1]. The ADA's press release lists "new guidance on obesity pharmacotherapy dose individualization in people with diabetes" among the year's notable updates, along with new guidance on treating obesity in people with type 1 diabetes ^[2].

Semaglutide is the molecule in Ozempic, Wegovy and Rybelsus; tirzepatide is the molecule in Mounjaro and Zepbound.

What else Section 8 says

The section frames weight management as a core part of diabetes treatment, not an add-on. Recommendation 8.4, also grade A, says weight management should be a primary goal of treatment alongside glycemic management in people with type 2 diabetes and overweight or obesity ^[1]. Recommendation 8.5 says weight loss of 5–7% of starting weight improves blood sugar and other intermediate cardiovascular risk factors, while sustained loss of more than 10% of body weight usually confers greater benefits, including disease-modifying effects and possible remission of type 2 diabetes ^[1]. For comparison, the section notes that metabolic surgery produces an average of more than 20% body weight loss ^[1].

On monitoring, the ADA recommends screening for overweight and obesity with BMI annually, and increasing checks of obesity-related measurements to at least every three months during active weight management treatment ^[1]. The section uses the standard BMI categories: overweight is 25–29.9 kg/m², obesity class 1 is 30–34.9, class 2 is 35–39.9 and class 3 is 40 or higher ^[1]. It also acknowledges BMI's limits, noting it does not measure fat distribution or function and is prone to misclassification in very muscular people and those with low muscle mass ^[1].

Section 8 was endorsed by The Obesity Society for the third consecutive year ^[3]. The 2026 Standards were produced by the ADA's Professional Practice Committee, co-chaired by Mandeep Bajaj, MBBS, FRCP, and Rozalina G. McCoy, MD, MS ^[2].

Why it matters for patients

The Standards of Care are widely used by US clinicians and often referenced by insurers and health systems, so naming semaglutide and tirzepatide at grade A gives clinicians a citable basis for choosing those drugs over older, less effective weight-loss agents in people with diabetes.

The statement that treatment should continue past a weight goal speaks to a common coverage and counseling question: whether these are short courses or long-term therapy. The ADA's position is continuation, consistent with its framing of obesity as "a chronic, often relapsing disease" ^[1].

Recommendation 8.20 matters for anyone who has plateaued at a lower dose or who cannot tolerate escalation. The guideline says the best dose for an individual may not be the highest approved one ^[1]. What that means in a specific case is a conversation for a prescriber; the guideline does not set a number.

The sources do not address cost, insurance coverage or how Medicare and commercial plans will respond to the new language. That is not yet known.

What happens next

The full 2026 Standards are available now as a supplement to the January 2026 issue of Diabetes Care, and in the ADA's Standards of Care app ^[2]. An Abridged Standards of Care for primary care professionals is planned for release in spring 2026 in Diabetes, Obesity, and Cardiometabolic CARE ^[2]. Through the ADA's "living" Standards of Care process, the online version and related materials are updated throughout the year to reflect new evidence and regulatory changes ^[2], which means recommendations 8.18 through 8.20 could be revised before the 2027 edition if new drugs or trial data arrive.